TKR Something isn’t right..

[dotski]

And case in point - I did a little too much on the foot peddler, a little too much time standing for a hair wash/grooming at the sink…and by the end of the day my knee had blown up bigger and was stiffer, hotter and more painful. Here comes another restless night trying to sleep to the sound of the hiss of the cryocuff running all night (will put in earplugs to dull the sound).

 

[Mutti3]

Yes, we all overdo it once! I walked around a running track at 3 weeks! As the natural healing progresses, you will be able to do things without making the knee angry!

 

[mendogal]

Some of us overdo it every couple of weeks ... It's natural after a period of improvement to test our limits and... OOPS!

 

[Cocopug]

Well, I ended up in emerg again after passing out and having a high heartrate for days. Had a concerning sign on ecg so they ordered a chest ct to rule out a lung blood clot. Still waiting for results and in lots of pain.

I was prescribed naproxen and opiates after TKR and later that week I got diverticulitis and irregular heartbeat and shockingly high blood pressure had to call an ambulance. Had a strange ECG and ultra sound of my heart and now on blood thinners. I think it was side effects from the medicine. Not 100% sure but it’s a bit coincidental. Hope you feel better soon

 

[Cinders2023]

One of them was to use a small hand massager over sensitive areas to desensitize the tissue so I tried it and lo and behold my knee bent with less pain in that previously painful spot.

I can’t use it on the actual knee, but use one on the muscles in my quad and calf areas and it does loosen them up to get more stretch/bend. I also have had luck using a tens unit above and below the knee.

 

[dotski]

Well, I ended up in emerg again after passing out and having a high heartrate for days. Had a concerning sign on ecg so they ordered a chest ct to rule out a lung blood clot. Still waiting for results and in lots of pain.

I was prescribed naproxen and opiates after TKR and later that week I got diverticulitis and irregular heartbeat and shockingly high blood pressure had to call an ambulance. Had a strange ECG and ultra sound of my heart and now on blood thinners. I think it was side effects from the medicine. Not 100% sure but it’s a bit coincidental. Hope you feel better soon

Sometimes it is hard to know cause/effect vs coincidence. Naproxen inhibits prostaglandins in the GI tract, but they are needed there to provide continual regeneration of the intestinal lining. It could have been a factor. It is well known for having side effect of blood pressure increase and arrhthmias. I kind of wonder about the opiates myself as being a factor in my elevated heartrate.

I saw OS today to get my staples taken out. Wound looks good. He didn’t even bother to touch my leg or measure ROM! I was happy about that. I had it bent up on the table so I guess he could see that there was some bend (probably about 70 degrees). Wants to re-X-ray in 4 weeks and see me again then. Was a bit concerned about my low hbg and high heartrate but admitted he didn’t know much about iron infusions,etc. he wanted to know I was getting repeat blood work (which I did this morning but don’t have the results yet). He wondered if I had tried NSAIDs for pain relief, knowing I can’t do Tylenol until my liver enzymes are normal. He was open to me trying celebrex, as well as renewing Flexeril for muscle spasm and sleep, but with a caution that flexeril can be hard on the liver in excess. I wish I didn’t need anything, but I can’t go without sleep. I’m hoping I can stop the tramadol soon as I feel really groggy/impaired by it.
I guess I will see what my hbg (iron) is like and if it isn’t coming up yet, ask my PCP about whether she thinks an infusion would help speed up my recovery.

 

[Layla]

He was open to me trying celebrex, as well as renewing Flexeril for muscle spasm and sleep, but with a caution that flexeril can be hard on the liver in excess. I wish I didn’t need anything, but I can’t go without sleep.

What about Magnesium? Wondering if you've considered it, or tried it?

Magnesium supports the following:
Bone health
Healthy blood sugar
Cardiovascular health
Muscle relaxation and nerves
Promotes healthy sleep (falling asleep and staying asleep)

An article on Magnesium -
https://bonesmart.org/forum/threads/magnesium-is-a-star.20301/

I hope you find relief in both areas soon.

 

[dotski]

Thanks @Layla yes absolutely to magnesium! I recently switched from my usual magnesium bisglycinate (that doesn’t cause diarrhea) to an oxide blend hoping that it will …ahem…help the bowels along. Would be nice to not need stool softeners and suppositories. Can’t say I really notice a difference so far. I’ve been on magnesium for a long time (it and compression socks cured my restless legs syndrome). I’m afraid it isn’t enough for when my muscles get into the vicious cycle of tightness. Usually a hot bath and massage will help, and a good yoga session and foam roller/myofascial balls. But I can’t do those things yet. Cannot wait to be able to soak in my bathtub!

 

[dotski]

For anyone following this thread (thank you!!)….how long after surgery was it before your OS said you could get into your own bathtub to soak? How about a public swimming pool hot tub? I forgot to ask at my 2 week check yesterday

All I know is that tomorrow I can take a shower without covering up the incision, that has healed well so far.

 

[sistersinhim]

The best thing you can do is call and ask your doctor about the tubs and pool. You have to have no open areas at all. Any tiny opening can allow bacteria to enter into your skin and possibly down into your knee. It is so much better to be extra careful!

That shower will feel like heaven on earth! Mine sure did!

 

[dotski]

The best thing you can do is call and ask your doctor about the tubs and pool. You have to have no open areas at all. Any tiny opening can allow bacteria to enter into your skin and possibly down into your knee. It is so much better to be extra careful!

That shower will feel like heaven on earth! Mine sure did!

Thank you, for sure I will check with my doc and follow that advice.

I would still love to know what others were advised about how long before they advised soaking or getting in the pool. Curious what is the breadth of advice about this in other places.

 

[Toothfairy]

Common answers online here in U.K. seem to be around 6 weeks as long as your incision is totally closed but I would always check with my medical team. No point in taking any risks.

 

[Jockette]

My surgeon put me in Pool PT at 4 weeks, to the day, post op. I now question this protocol. I had no idea what I was doing then so I was compliant with all directions. I’m assuming he was satisfied that my incision was healed.

My first pool session was 50 minutes long. I did countless exercises for those 50 minutes. My leg swelled big time and it took me 3 days to “recover” (and I use the word loosely) and a fear that something was wrong with my knee. That was the end of my compliance!

Be very careful in a pool, especially early in recovery, it is way too easy to overdo and then pay a big price, even if we think it feels great at the time. (My experience did not feel great at the time!) We can cause increased pain and swelling quickly, but it doesn’t go away quickly.

 

[dotski]

My surgeon put me in Pool PT at 4 weeks, to the day, post op. I now question this protocol. I had no idea what I was doing then so I was compliant with all directions. I’m assuming he was satisfied that my incision was healed.

My first pool session was 50 minutes long. I did countless exercises for those 50 minutes. My leg swelled big time and it took me 3 days to “recover” (and I use the word loosely) and a fear that something was wrong with my knee. That was the end of my compliance!

Be very careful in a pool, especially early in recovery, it is way too easy to overdo and then pay a big price, even if we think it feels great at the time. (My experience did not feel great at the time!) We can cause increased pain and swelling quickly, but it doesn’t go away quickly.

Thank you so much for the caution. I am so sorry it was too much too soon for you. I should imagine the resistance the water gives requires a good degree of strength. I wonder if the cooling effect of the water kind of acts as a temporary analgesic and makes it easy to do too much.

 

[Jockette]

People mention feeling weightless in a pool, so maybe that‘s another aspect of why it’s easy to do too much. The pool I was in was at a YMCA, and was heated. They had an instructor from my PT office leading it. There were also a lot of people in the pool, and it was a big pool. That many people gave the water too much movement. My balance was still off, and of course I couldn’t use my cane in the pool. I was so scared with nothing to hold onto. Everyone else seemed happy to be there. I felt so intimidated. I’m not crazy about pools, any way, so all in all it was a very bad experience. I did not go back to pool “therapy!”

The only good thing that came out of it for me was, I went home and googled “stopping therapy” and found Bonesmart! It was a game changer!

 

[Layla]

I wonder if the cooling effect of the water kind of acts as a temporary analgesic and makes it easy to do too much.

The buoyancy of water reduces the weight-bearing load on the knee, allowing for ease in movement without undue stress on the joint...but when you get out, you can feel that you worked out, especially if you overdo it which is understandably easier do do than when exercising on land. I think the warmer the water, likely all the more soothing.

 

[dotski]

POD17: the good: I finally had a stretch of sleep about 4 hours after having memory foam topper put on mattress. And maybe another hour after. I’ve been sleeping with my Aircast brand cryocuff running all night and foot elevated above heart, other than the times I attempt side lying for tailbone relief. At my 2 week check my surgeon asked if I had a cryocuff - clearly he is a fan of them. And I had my first shower today. I was exhausted after. My heart goes out to people who live alone and/or have shoulder or other body part issues to further challenge basic mobility.

The bad: my quads still won’t fire properly. I can engage them when leg straight (on bed) enough to move the kneecap. It stings a bit. But I’m no where close to being able to extend my foot in sitting. I still need to use my hand or cane to move my foot. My kneecap seems to not be stuck - I can move it around with my hands.
Walking - I have trouble with heel-toe walking because:
1. Knee doesn’t bend well - my best guess is 70 degrees if I push it to the point of discomfort. The actual comfort range is probably only about 30-40.
2. I have no strength to extend my foot to land on my heel. It takes so much effort.
Prior to surgery I had strong quads. They are wasting away in front of my very eyes

My knee is so swollen all the time. It doesn’t go down at night. I never sit with it down. I wear compression hose 24/7. I put foot straight up a wall sometimes. None of it seems to help. I do basically no housework or cooking, dishes, etc (maybe only make cup of tea or reheat something). As soon as the ice comes off it goes red and warm. (No sign of infection otherwise and my most recent bloodwork came back looking good. The CRP went down as it should by this point).

I am trying to be positive but my last PT cautioned about a 2 week window to get 90 degrees (yeah I know!). And I have a new appt coming up with outpatient PT…and I have half a mind to cancel because I’m scared of getting pushed and it just blowing up more. Plus I’m wanting my incision to be a bit better healed. I don’t like the cracks I could see in it, so I put a bandage on it today after my shower. It didn’t look like it was draining, but I just don’t like like that I can see the split with fresh granulation tissue.

I am really scared of this knee getting stiff and this inflammation never going away. I need ROM for everything I love to do - Xc ski, bike, yoga, work (involves squatting and kneeling sometimes). I’m hardly doing anything but it is still so angry. I quit trying the foot peddler as I wonderedif it was the cause - it doesn’t feel good, it is uncomfortable. But PT said I need to do 5 minutes every 2 hours to get the swelling inside joint out. That the knee needs movement. But movement of any kind seems to make it blow up.
(Edited to add: at this rate I can’t imagine being back to work by 12 weeks. The disability management team have already contacted me and I haven’t returned the call as I just can’t face it…)

 

[Jockette]

I’m hardly doing anything but it is still so angry. I quit trying the foot peddler as I wonderedif it was the cause - it doesn’t feel good, it is uncomfortable. But PT said I need to do 5 minutes every hour to get the swelling inside joint out. That the knee needs movement. But movement of any kind seems to make it blow up.

Yes, you are in what we call the Angry Tissue Stage. You know that it will heal in time, but it does take time. Yes, your knee needs mobility but 5 minutes is obviously too long right now for your knee. You were wise to stop doing something that was causing more harm than good. Just because your PT, or even your surgeon, recommends something doesn’t mean you must agree and do it.

Take charge of your recovery, take things slow and easy for a while and trust your body to know how to heal. You will have that ROM needed to do all those things you love to do!

 

[dotski]

Aw, thank you @Jockette i don’t know how many times I will have to repeat it to believe it. I work in rehab (OT) and just want to hide. Everyone at work, well meaning, said I was going to do great and would be back on my feet before I know it. Before my surgery I regularly caught a glimpse of patients I met in hospital walking in for their first outpt PT appt, walking well with a cane, looking very happy. The outpatient PT (before surgery) even suggested maybe I’d be back to doing light duties by 6 weeks. Ironically part of my light duties might involve “prehab” phone calls to patients having TKR/THR surgery - to ensure they have the equipment and are prepared. I suppose I will have an even greater level of empathy…hope I don’t scare anyone off!

 

[Jockette]

and just want to hide. Everyone at work, well meaning, said I was going to do great and would be back on my feet before I know it.

I can relate to this in that I had a PKR. All I read about PKRs before hand, and all my surgeon’s office did, and did not say, made me think I would be completely healed in a total of 6-8 weeks. Unfortunately, I had a very tough first year, nothing like the quick recovery I was led to believe I’d have.

I’m so glad I found Bonesmart when I was 4 weeks post op and I realized I was actually very normal. I wish I had found Bonesmart before my surgery, it would have saved me a lot of misery in unreasonable expectations.

I‘m sure this experience will enhance your ability to relate to your patients. Telling them gently what to expect will help them a lot.